Moving Schizophrenics into the Community Does Not Increase Crime
In the study, schizophrenic men from both the 1975 and 1985 groups were more likely than controls to have a criminal record (24% vs. 7.4%), and they had higher rates of criminal convictions than controls in all categories except sexual offenses. The overall patterns of offending from 1975 to 1985, however, did not differ statistically between schizophrenics and controls.
The researchers write that the increased number of convictions in those with schizophrenia in the 1985 group compared with the 1975 group seems to reflect an increase in the general population. "Changes in the pattern of mental health services, with the shift to community care, [were] not marked by any significant change in relative rates of conviction for those first admitted to hospital with schizophrenia."
A psychiatric epidemiologist, who works with a community-based treatment program for mentally ill people judged not guilty by reason of insanity, tells WebMD that such programs need community support and adequate resources to work.
"Why would someone with a history of mental illness commit some violent act? It's usually the people who are not adhering to their treatment regimen, they have problems with substance abuse, or there's no effective treatment in the community, so they're not getting the treatment that they need for it," says Howard Kravitz, DO, MPH, associate professor of psychiatry and preventive medicine and director of research for the section of psychiatry and the law at Rush-Presbyterian-St. Luke's Medical Center in Chicago. Kravitz was not involved in the study.
"Overall, among psychiatry patients you probably don't have a higher risk [of crime] for people with serious mental illness. The problem is that you've got a small group that will go out and commit violent acts, and those are the people who make the headlines."
The study's authors say that mental-health services should aim to reduce the higher crime rates associated with schizophrenia, but that a move away from community care is not likely to help.
"To return to a situation in which those individuals in the early stages of a schizophrenic illness spend extended periods in institutions will require the clock to be turned back several decades, and its influence on offending, if any, remains unclear," they write, but they go on to emphasize that "community care may not be responsible for the raised rates of offending, but it will be held responsible if it does not actively address the prevention of that offending."